The influence of cardiopulmonary bypass priming without FFP on postoperative coagulation and recovery in pediatric patients with cyanotic congenital heart disease

Abstract

Prophylactic use of FFP in the priming solution does not have obvious clinical benefits in cyanotic congenital heart disease (CCHD) patients. Gelofusine, an artificial colloid, is a safe and effective substitute of FFP in the priming solution. Furthermore, r-TEG can be used as a "real-time" assessment tool to evaluate postoperative bleeding and guide transfusion after cardiac surgery in pediatric patients.

Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery

“…The blood transfusion strategy was improved to limit blood product usage. However, in our previous prospective randomized studies with a small sample size, the use of gelatin as FFP replacement indicated a tendency for decreased blood products while CPB management and transfusion strategy remained unaltered. Therefore, decreased transfusion requirements may be associated with a new priming strategy, which is considered key to the multimodal approach of restrictive transfusion policy in pediatric patients undergoing cardiac surgery .…”

“…Gelatins differ from other nonprotein colloids due to the absence of dose limitation, without any accumulation in the body and therefore, associated with few adverse effects . In our prospective randomized controlled trials, 100 cyanotic pediatric patients (aged 6 months to 3 years) and 80 pediatric patients (aged less than 3 years) undergoing cardiac surgery were randomly divided into plasma and gelatin groups with different priming strategies. The postoperative coagulation and recovery indicators in both groups were comparable, which prompted our center to substitute succinylated gelatin for FFP in pediatric cardiac surgery.…”

Assessment of coagulation profile by thromboelastometry in adult patients with cyanotic congenital heart disease

“…Limited data on the utility of perioperative monitoring of TEG and the results of therapy in cyanotic children undergoing complex cardiac surgery is available [35][36][37] and there are even fewer data on this using rotational thromboelastometry [38].…”

Effect of two different colloid priming strategies in infants weighing less than 5 kg undergoing on‐pump cardiac surgeries

“…Therefore, artificial colloids have been developed as alternatives and are increasingly used in clinical practice. Miao et al conducted a randomized controlled trial in 2014 to compare the clinical effects of different colloid priming (with and without fresh frozen plasma) for 6‐months to 3‐years‐old infants, and found that total artificial colloid priming did not increase postoperative blood products consumption or affect the pediatric coagulation function, which confirmed the safety of artificial colloid priming in pediatric CPB. Subsequently, Wang et al conducted a retrospective analysis and found that the priming strategy with gelatin during CPB did not affect children’s postoperative coagulation function.…”